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After the early influence of classical music, Bishara began experimenting with electronic and experimental music, becoming interested in Tangerine Dream. He became engrossed in horror film scores after watching the silent film The Cabinet of Dr. Caligari and the horror classic Nosferatu.[1] In the late 1980s he became a member of the industrial band Yesterday's Tears, which later was known as Drown. By around 1994, he was signed to a record and touring contract with Drown.[2]

He began to be the subject of more media attention with the James Wan film Insidious in 2011. The New York Times film critic Mike Hale remarked that Bishara's score helped the film recover from some of its negative attributes such as "pedestrian camerawork".[4] Writing for Howlin' Wolf Records, Jason Comerford referred to the score as a "dense, bristling effort jam-packed with invention and energy".[3] The score was performed by a string quartet accompanied by Bishara producing sounds on a rusted piano using hammers, files, and other "experimental instruments" of his design. Much of the score was recorded before Wan began shooting the film, the musicians improvising some parts as they went along but following Bishara's broad structure and concept. Bishara began sending completed recordings to Wan as he was editing the film so Wan could work the score into the film according to the structure he desired. Though film score composers are typically more involved in music placement, Bishara noted the process used on Insidious felt "free".[3] Bishara also acted in the film, portraying a demon that served as the film's main antagonist.[5]

Bishara went on to score the Darren Lynn Bousman film 11-11-11. In 2013, Bishara worked with Scott Stewart to score the science fiction horror film Dark Skies. Writing for Film Journal International, Justin Lowe referred to the score as "unnerving" but suitably within the background of the action.[6] He then reunited with director Wan to compose the score for The Conjuring.[7] He also portrays an entity named Bathsheba in the film.[8] Wan's producers gave him wide latitude to decide who he wanted to work with him on the film, so he brought back many of the crew from Insidious, including Bishara.[9] Bishara scored the sequel to Insidious, Insidious: Chapter 2 (2013), but did not return to portray the demon.[10]

Bishara is known to be fond of horror, and he has stated that he favors composing for the genre above others: "It is the one that had the most energy for me. There always just seemed to be something a little bit more compelling about being on the edge of everything going away."[16] He is known for his avant-garde style and unique approach to instrumentation and composition that suits horror films particularly well.[17][18] Music journalists have noted his disregard for horror film score conventions, employing "gut-wrenching string dissonance, haunting electronic sounds and sudden crescendoes"[19] and using strings and percussion to create effects designed to evoke "maximum shock effect" in the listener.[20]